Basic Information
| Provider Information | |||||||||
| NPI: | 1689033714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDHEIMER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | EDWARDS | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 168 N CHURCHILL DR | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573537500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 488 N MAIN ST | ||||||||
| Address2: | SUITE #204 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300092386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706195801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2016 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT012271 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.